Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression

Abstract Background The potential link between sleep disorders and suicidal behaviour has been the subject of several reviews. We performed this meta-analysis to estimate the overall association between sleep disorders and suicidal behaviour and to identify a more specific relationship in patients with depression. Methods A systematic search strategy was developed across the electronic databases PubMed, EMBASE and the Cochrane Library from inception to January 1, 2019 for studies that reported a relationship between sleep disorders and suicidal behaviour in depressed patients. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to measure the outcomes. Heterogeneity was evaluated by Cochran’s Q test and the I2 statistic. The Newcastle-Ottawa Scale (NOS) was adopted to evaluate the methodological quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. We calculated the overall association between sleep disorders and suicidal behaviour and estimated more specific categories, including insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempt, and completed suicide. Results A total of 18 studies were included in this study. Overall, sleep disorders were closely related to suicidal behaviour in patients with depression (OR = 2.45 95% CI: 1.33 4.52). The relatively increased risks of sleep disorders with suicidal ideation, suicide attempt and completed suicide ranged from 1.24 (95% CI: 1.00 1.53) to 2.41 (95% CI: 1.45 4.02). Nightmares were found to be highly correlated with the risk of suicidal behaviour (OR = 4.47 95% CI: 2.00 9.97), followed by insomnia (OR = 2.29 95% CI: 1.69 3.10). The certainty of the evidence was rated as very low for the overall outcome and the major depression subgroup and was rated as low for the depression subgroup. Conclusions This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients. Considering that all included studies were observational, the quality of the evidence is rated as very low. More well-designed studies are needed to confirm our findings and to better explain the mechanisms by which sleep disorders aggravate suicidal behaviour in depressed patients.

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Meta-analysis of risk factors associated with suicidal ideation after stroke: A focus on Asian populations

10.21203/rs.3.rs-26734/v1 ◽

2020 ◽

Author(s):

Shuang Mei zhang ◽

Zhao yang Qiu ◽

Wei feng Zhu ◽

An rong Wang ◽

zhaoxu zhang

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Sleep Disorders ◽

Household Income ◽

Meta Analysis ◽

Cochrane Library ◽

Stroke Survivors ◽

Asian Populations ◽

One Year ◽

Underlying Risk

Abstract Background Over the past decade, increasing attention has been paid on post-stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. Methods We systematically searched the Cochrane library, Embase, PubMed,CNKI and Web of Science databases from their inception until April 2019. The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. Results A total of 12 studies (n = 2693036) were included for meta-analyses. Of these studies, 7 reported suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including men, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, alcohol consumption, low family income, depression, heart disease and sleep disorders were the important risk factors for the pathogenesis of suicide after stroke. When compared to PSS more than one year, the incidence of suicide within one year after stroke was more likely to be statistically significant. It was found that 4 out of every 1,000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. Conclusion Despite some limitations, we successfully identified the prevalence of PSS in Asian populations and the underlying risk factors. Based on the results of this meta-analysis, 4 out of every 1,000 stroke survivors committed suicide and the individuals with suicidal ideation tended to suicide within one year after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. In addition, stroke survivors with low household income had nearly double the risk of suicidal ideation, especially in Asian populations. Hence, targeting the identified risk factors may be helpful to improve stroke patient care and prevent suicidal ideation after stroke.(Registration No. CRD42019128813).

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Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: A network meta-analysis

General Psychiatry ◽

10.1136/gpsych-2018-000016 ◽

2018 ◽

Vol 31 (2) ◽

pp. e000016

Author(s):

Liang Su ◽

Zheng Lu ◽

Shenxun Shi ◽

Yifeng Xu

Keyword(s):

Primary Outcome ◽

Meta Analysis ◽

Cochrane Review ◽

Acute Stage ◽

Chinese Patients ◽

Cochrane Library ◽

Assessment Development ◽

Excessive Sedation ◽

Made In

BackgroundAgitation is very common in patients with acute stage schizophrenia, and injection of antipsychotics and clonazepam is widely used. Network meta-analysis of these comparisons among three injection treatments has been seldom reported.AimTo compare the efficacy and safety of various injections for agitation symptoms in Chinese patients with schizophrenia.MethodsSearches were made in PubMed, Embase and Web of Knowledge, Cochrane Library, Wanfang data, CNKI, SinoMed and VIP databases up to 18 February 2018. Standard search strategies were performed by two reviewers according to the Cochrane Review Group. The Consolidated Standards of Reporting Trials statement was used to assess the methodological quality of the studies. STATA was used to perform meta-analysis. The Cochrane Grades of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the strength of evidence.ResultsA total of 15 studies were included in the network meta-analysis. There were 11 studies comparing ziprasidone with haloperidol, and four studies comparing haloperidol with clonazepam. The results showed that ziprasidone is more effective than haloperidol and clonazepam (sucra: 77.2, 72.8 and 0) in the treatment of agitation symptoms. There was the effect size (standardised mean difference (SMD)) in the three groups: haloperidol: SMD=2.278, 95% CI 1.836 to 2.719; ziprasidone: SMD=2.536, 95% CI 2.082 to 2.990; and clonazepam: SMD=1.360, 95% CI 0.127 to 2.593. The acceptability was assessed by the incidence of excessive sedation, which showed that ziprasidone and haloperidol were similar with both being superior to clonazepam (sucra: 0.3, 0.7 and 99.0). Ziprasidone had significantly less adverse effects than haloperidol in effects of extrapyramidal system (EPS) (z=5.01, p<0.001). There were no statistically significant differences between haloperidol and ziprasidone in tachycardia and abnormal ECG (z=1.69, p=0.091; z=0.87, p=0.386; respectively). Based on GRADE, the strength of the evidence for primary outcome was ‘medium’.ConclusionOur results suggested that ziprasidone was more suitable than haloperidol and clonazepam in the treatment of agitation symptoms in Chinese patients with schizophrenia, according to the efficacy and acceptability of these three intramuscular injection medications.

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Acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis

Acupuncture in Medicine ◽

10.1177/09645284211009542 ◽

2021 ◽

pp. 096452842110095

Author(s):

Xu Kuang ◽

Wenjuan Fan ◽

Jiawei Hu ◽

Liqun Wu ◽

Wei Yi ◽

...

Keyword(s):

Cognitive Impairment ◽

Subgroup Analysis ◽

Meta Analysis ◽

Cochrane Library ◽

Qualitative Synthesis ◽

China National Knowledge Infrastructure ◽

Quality Of Evidence ◽

Post Stroke ◽

Assessment Development

Objectives: The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI). Methods: The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3. Results: A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, p < 0.00001; heterogeneity: χ2 = 35.52, p = 0.0007, I2 = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, p < 0.00001; heterogeneity: χ2 = 269.75; p < 0.00001; I2 = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation. Conclusion: Acupuncture could be effective and safe for PSCI. Nevertheless, the results should be interpreted cautiously due to the high ROB of included trials and very low quality of evidence for assessed outcomes.

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The effects of educational interventions on suicide: A systematic review and meta-analysis

International Journal of Social Psychiatry ◽

10.1177/0020764019852655 ◽

2019 ◽

Vol 65 (5) ◽

pp. 399-412 ◽

Cited By ~ 5

Author(s):

Isabella Pistone ◽

Ulrika Beckman ◽

Erik Eriksson ◽

Helena Lagerlöf ◽

Morten Sager

Keyword(s):

Systematic Review ◽

Suicidal Ideation ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Meta Analysis ◽

Educational Interventions ◽

Quality Of Evidence ◽

School Based ◽

Education Interventions

Background: Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour are widely used, although little is known regarding the collective effectiveness of these interventions. Aim: We evaluated the existing evidence for the effectiveness of education interventions in the prevention of suicidal behaviour. Methods: In this systematic review and meta-analysis, we searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were combined in meta-analyses. Results: We identified 41 studies evaluating two different types of interventions: school-based education interventions and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary depending on subjects’ personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the estimate, according to GRADE criteria, was rated as very low. Conclusion: The results of this study indicate that school-based education interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and implementation of educational interventions should focus on participants’ individual characteristics.

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Lavender for Sleep Disorder Management in Menopausal Women with or without Hypertension: A Systematic and Meta-analysis

Tabari Biomedical Student Research Journal ◽

10.18502/tbsrj.v3i1.6175 ◽

2021 ◽

Author(s):

Mehdi Mameneh ◽

Ali Rokni ◽

Masumeh Ghazanfarpour ◽

Masoudeh Babakhanian

Keyword(s):

Sleep Disorders ◽

Web Of Science ◽

Sleep Problems ◽

Meta Analysis ◽

Cochrane Library ◽

Quality Of Sleep ◽

Isi Web Of Science ◽

Menopausal Women ◽

Post Menopausal

Introduction: Regarding the prevalence of sexual problems during menopause and the interest of women in the use of aromatherapy in attenuating the sleep disorders, and due to the lack of comprehensive meta-analysis on the effects of aromatherapy on the sleep disorders, the present study was conducted to determine the effect of lavender on the sleep disorders in postmenopausal women.Material and Methods: The following databases were selected to search systematically the effect of lavender on the quality of sleep in post-menopausal women, including PubMed, Cochrane Library, ISI Web of Science and Scopus, regardless time limit since inception to September 29, 2019. The quality of trials was investigated according to Jadad scale.Results: After combination of the result of four trials, our meta-analysis showed that treatment with lavender was more effective than placebo in respect with improvement of quality of sleep in menopausal women (Standardized Mean Difference=1.098; Confidence Interval 95%: 0.33-1.86; P= 0.005).Conclusion: Considering the effects of lavender essential oil on improving the quality of sleep in postmenopausal and middle-aged women, this medication can be prescribed in the clinics of sleep problems, obstetrics and gynecology.

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Cancer and suicidal ideation and behaviours: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-020463 ◽

2018 ◽

Vol 8 (8) ◽

pp. e020463 ◽

Cited By ~ 2

Author(s):

Raffaella Calati ◽

Fang Fang ◽

Elizabeth Mostofsky ◽

Qing Shen ◽

Valentina Elisabetta Di Mattei ◽

...

Keyword(s):

Systematic Review ◽

Suicidal Ideation ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Team Members ◽

Assessment Development ◽

Study Heterogeneity ◽

Ethical Approval ◽

Newcastle Ottawa Scale

IntroductionPrevalence of suicidal ideation (SI) and behaviours are higher among patients with cancer than general population. No systematic review/meta-analysis investigated this topic; therefore, our aim will be to assess the relationship between cancer and SI and behaviours.MethodsWe will search PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, PsycINFO and Cochrane Library databases from their inception until 30 June 2018. Case–control and cohort studies focused on the association between cancer (any type) and suicidal outcomes (suicide, suicide attempt and SI) will be included. Two team members will independently: (A) perform the selection of the included studies and data extraction, with the supervision of a third member in case of discrepancies and (B) assess each study with: (1) Newcastle-Ottawa Scale (NOS); (2) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement; (3) Grading of Recommendations Assessment, Development and Evaluation (GRADE). We will conduct a random-effects meta-analysis. Individual and pooled ORs and associated 95% CIs will be calculated as well as between-study heterogeneity. We will examine the potential for publication bias. If possible, we will explore reasons for potential between-study heterogeneity.Ethics and disseminationThis study does not require ethical approval. The study will be submitted to a peer-reviewed journal, will be publicly disseminated and will be the topic of research presentations.PROSPERO registration numberCRD42017072482.

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Correction: Alcohol-Related Risk of Suicidal Ideation, Suicide Attempt, and Completed Suicide: A Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0241874 ◽

2020 ◽

Vol 15 (10) ◽

pp. e0241874

Author(s):

Nahid Darvishi ◽

Mehran Farhadi ◽

Tahereh Haghtalab ◽

Jalal Poorolajal

Keyword(s):

Suicidal Ideation ◽

Suicide Attempt ◽

Meta Analysis ◽

Completed Suicide ◽

Related Risk

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Corticosteroids for Treating Sepsis in Adult Patients: A Systematic Review and Meta-Analysis

Frontiers in Immunology ◽

10.3389/fimmu.2021.709155 ◽

2021 ◽

Vol 12 ◽

Author(s):

Huoyan Liang ◽

Heng Song ◽

Ruiqing Zhai ◽

Gaofei Song ◽

Hongyi Li ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Evaluation Methodology ◽

Cochrane Library ◽

Assessment Development ◽

Short Time ◽

Long Term Mortality

ObjectiveCorticosteroids are a common option used in sepsis treatment. However, the efficacy and potential risk of corticosteroids in septic patients have not been well assessed. This review was performed to assess the efficacy and safety of corticosteroids in patients with sepsis.MethodsPubMed, Embase, and Cochrane library databases were searched from inception to March 2021. Randomized controlled trials (RCTs) that evaluated the effect of corticosteroids on patients with sepsis were included. The quality of outcomes in the included articles was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The data were pooled by using risk ratio (RR) and mean difference (MD). The random-effects model was used to evaluate the pooled MD or RR and 95% confidence intervals (CIs).ResultsFifty RCTs that included 12,304 patients with sepsis were identified. Corticosteroids were not associated with the mortality in 28-day (RR, 0.94; 95% CI, 0.87–1.02; evidence rank, moderate) and long-term mortality (>60 days) (RR, 0.96; 95% CI, 0.88–1.05) in patients with sepsis (evidence rank, low). However, corticosteroids may exert a significant effect on the mortality in the intensive care unit (ICU) (RR, 0.9; 95% CI, 0.83–0.97), in-hospital (RR, 0.9; 95% CI, 0.82–0.99; evidence rank, moderate) in patients with sepsis or septic shock (evidence rank, low). Furthermore, corticosteroids probably achieved a tiny reduction in the length of hospital stay and ICU. Corticosteroids were associated with a higher risk of hypernatremia and hyperglycemia; furthermore, they appear to have no significant effect on superinfection and gastroduodenal bleeding.ConclusionsCorticosteroids had no significant effect on the 28-day and long-term mortality; however, they decreased the ICU and hospital mortality. The findings suggest that the clinical corticosteroids may be an effective therapy for patients with sepsis during the short time.Systematic Review Registrationhttps://inplasy.com/wp-content/uploads/2021/05/INPLASY-Protocol-1074-4.pdf

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Meta-analysis of risk factors associated with suicidal ideation after stroke

Annals of General Psychiatry ◽

10.1186/s12991-021-00378-8 ◽

2022 ◽

Vol 21 (1) ◽

Author(s):

Shuangmei Zhang ◽

Anrong Wang ◽

Weifeng Zhu ◽

Zhaoyang Qiu ◽

Zhaoxu Zhang

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Suicidal Ideation ◽

Sleep Disorders ◽

Family Income ◽

Meta Analysis ◽

Cochrane Library ◽

Future Research ◽

Factors Associated ◽

Complications Of Stroke

Abstract Background Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. Methods We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. Results A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. Conclusion PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).

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Effectiveness of Pharmacological Pain Relief Methods on Birth Experience: A Systematic Review and Meta-Analysis

Current Women s Health Reviews ◽

10.2174/1573404817999201230234158 ◽

2020 ◽

Vol 17 ◽

Author(s):

Solmaz Ghanbari-Homayi ◽

Sonia Hasani ◽

Hojjat Pourfathi ◽

Mojgan Mirghafourvand

Keyword(s):

Pain Relief ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Library ◽

Secondary Outcome ◽

Birth Experience ◽

Pharmacological Interventions ◽

Assessment Development ◽

Group Grade

Background:: The use of pharmacological pain relief methods during labour is increasing, however there is no clear evidence that pharmacological interventions can also improve women’s satisfaction with birth experience. Objective:: To assess the effectiveness of pharmacological interventions on women's satisfaction with birth experience (primary outcome) and satisfaction with the received method (secondary outcome). Methods:: We searched databases in English (MEDLINE, Cochrane Library, Embase, ProQuest, Scopus and Web of Science) and Persian languages (SID and Magiran) from inception until April 30, 2018 for clinical trials that pharmacological pain relief methods were compared with standard or routine cares, or non-pharmacological methods. The evaluation of studies in term of risk of bias was conducted using the Cochrane Handbook. Meta-analysis results were reported as OR and 95% confidence interval. In meta-analysis, subgroup analysis was performed based on the type of intervention. Due to the heterogeneity of over 30%, random effect was reported instead of the fixed effect. The heterogeneity was evaluated using I2, T2 and Chi2. The evaluation of the quality of the studies was also examined using the Grading of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. Results:: The results of 7 studies with low-quality in meta-analysis, showed that pharmacological methods significantly improved satisfaction with birth experience (OR = 2.99; 95% CI: 1.37 to 6.52; P = 0.006). However, meta-analysis of subgroups showed that only inhalation of Entonox gas (OR = 6.51; 95% CI: 3.47 to 12.22; P < 0.001), in contrast to epidural analgesia (OR = 1.19; 95% CI: 0.62 to 2.27; P = 0.60) and Hyoscine injection (OR = 2.58; 95% CI: 0.93 to 7.20; P = 0.07) significantly improved satisfaction with birth experience. Conclusion:: Pharmacological interventions such as epidural, although introduced as one of the effective methods for pain relief, may not provide women with satisfaction with birth. However, more studies with precise methodology, high sample size, and standard tools should be performed to more accurately investigate the effect of pharmacological interventions on birth experience.

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